Health Insurance

The two basic types of health coverage available to Texans are:

A). Traditional Plans (also indemnity or fee-for-service plans) that allow you to go to any physician you choose but require that you pay for the services and file claims for reimbursement. Generally, you pay a deductible and a percentage of the doctor's charge (or co-insurance).

B). Managed Care Plans use networks of selected doctors and other providers to provide comprehensive health services. The different types of managed care plans include:

1. Health maintenance organization (HMO)--require that you use network physicians, hospitals and other health care providers. HMOs also eliminate the need to file claims.
2. Preferred provider organization (PPO)--has a provider network like an HMO, but differs from an HMO because it provides some coverage for services by providers outside the network.
3. Point-of-service (POS) POS plans or riders may be available with some HMOs. A rider is a written agreement that may add or exclude specific coverage.

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